Epilepsy in Children

According to the American Epilepsy Society, about 326,000 children under age 15 have epilepsy. Epilepsy is a neurological disorder in which nerve cells in the brain send abnormal signals to other nerve cells and muscles throughout the body. These signals can cause seizures, unusual sensations, or different behaviors. People of all ages live with epilepsy, however, the first seizure or manifestation occurs most often in childhood or in older adulthood. This year, another 200,000 people in the United States will be diagnosed with epilepsy.

When seizures in children happen more than several times or with regularity, the child may have epilepsy or a seizure disorder. At The Valley Hospital's Pediatric Epilepsy Monitoring Unit, we carefully evaluate and monitor patients from newborn to age 18 for several days in a comfortable private room. A parent is welcome to stay for the entire time in the child's room. After the monitoring has been completed, our medical director/epileptologist will interpret the results and make a diagnosis. If it is epilepsy, there are many different methods to manage it, including medications, diet, electrical stimulation and surgery.

Seizures and Epilepsy in Children

Seizures can be convulsions, brief periods of unconsciousness, or altered behavior. When seizures recur, a child may have epilepsy or a seizure disorder. Epileptic seizures are caused by a sudden and unusual discharge of electrical energy in the brain. Our brain cells need electrical energy to make us move, sense, think, remember, feel and live. But sometimes, these bursts of energy become unregulated and chaotic, and a seizure results.

Not all seizures are readily apparent. Many parents report that their children stare, appear far away, pause for a few seconds, blink, become unresponsive, faint and/or have trouble with their lessons in school. Sometimes a child may experience a change in personality and become either withdrawn or aggressive.

There are several types of seizures that children can experience:

generalized tonic-clonic (grand mal) seizures, when all muscles and motor functions are affected and the child loses consciousness, falls, stiffens and begins to jerk

absence (petit mal) seizures are brief periods of blank staring in which the child is unaware of his/her surroundings and unable to respond. Rapid blinking or chewing movements of the mouth may occur.

atonic seizures, which cause a sudden loss of muscle tone

myoclonic seizures, which are brief involuntary jerks

infantile seizures, which occur in clusters in babies, usually beginning at 6 months of age. The baby may look startled, draw his/her knees suddenly up to the stomach, and bring both arms up at the same time. If the baby is sitting, his/her head and arms may fall forward.

partial seizures, which do not cause a loss of consciousness but result in jerking movements of one part of the body. The child may appear to be in a dream or trance-like state and unable to respond.

What Causes Epilepsy*

Although no one knows yet when epilepsy begins, scientists have discovered several causes:

genetic predisposition

head injury during birth or from a severe blow on the head during infancy or childhood

tumors or diseases of the brain, including encephalitis and meningitis

In many cases, children who have mental retardation or cerebral palsy also have brain damage that produces seizures. Also, some forms of severe epilepsy in early childhood are associated with some degree of mental retardation. These include infantile spasms, some types of myoclonic epilepsy and Lennox Gastault syndrome. Some children do outgrow epilepsy as they age.

We Specialize in Epilepsy Monitoring

The Valley Hospital's Pediatric Epilepsy Monitoring Unit is under the medical direction of Jennifer A. Cope, M.D., a board-certified pediatric neurologist and neurophysiologist who specializes in epilepsy. She is joined by a team of pediatric registered nurses with extensive experience caring for children with neurologic conditions. There is 24-hour coverage by board-certified neurologists.

Our monitoring team is led by an EEG technologist who is registered by the American Board of Registration for Electroencephalography and Evoked Potential Technologists. The team consists of highly qualified and experienced technicians who work both in the adult and pediatric departments. These technicians perform such studies as long term monitoring in the pediatric intensive care unit, ECI (brain death study), sleep deprived, neonatal EEGs, portables and routine testing. All these studies help in diagnosing epilepsy, seizures and abnormal brain waves.

*Medical information from the Epilepsy Foundation of New Jersey.

For Your Child's Comfort

The Pediatric Epilepsy Monitoring Unit is a child-friendly place with a comfortable, private room for the patient. The unit is located on Valley's state-of-the-art pediatrics floor, which also includes general pediatrics beds and a Pediatric Intensive Care Unit (PICU).

One parent may stay with the child for the entire monitoring period. An around-the-clock brain wave EEG test and video camera technology provide Dr. Cope with information to make a diagnosis. The EEG measures brain waves through electrodes placed on the scalp and can detect abnormal changes that signal seizures. Sedation is not needed to attach the EEG leads to the child's head.

The video camera provides constant views of the patient for Dr. Cope and the nursing staff. If the parent needs a break or cannot stay with the child the entire time, rest assured that the nursing staff is monitoring the child at all times. Patients may also undergo blood testing and an imaging study of the brain (MRI, SPECT, or PET scan) while they are here.

Free television and telephone services are provided. There is also a video game system and plenty of toys, books and puzzles. Patients do not have to remain in bed. They may sit up in a chair, walk around the room, wear their own clothes and pajamas, and eat food brought from home. Children are welcome to bring their own blankets, "loveys," favorite toys, books, electronics and anything else that makes them feel comfortable.

Network Monitoring for Inpatients

Network monitoring equipment in The Valley Hospital allows the pediatric epilepsy team to evaluate and monitor acutely ill children in the Pediatric Intensive Care Unit without having to move them to the Pediatric Epilepsy Monitoring Unit.

Multiple Treatment Options

After Dr. Cope has interpreted the patient's epilepsy study, she will develop a treatment plan. Some children continue under Dr. Cope's care while others are referred back to their own neurologists. Treatment options include:

medications

vagal nerve stimulation, which involves the use of a small device implanted in the chest and attached to the vagal nerve (in the lower neck) that acts like a pacemaker to regulate electrical impulses in the brain and decrease the frequency of seizures

a ketogenic diet that has been proven to help patients with severe epilepsy

referral, when appropriate, for surgery to treat seizures that cannot be controlled any other way

Ongoing Research

The Pediatric Epilepsy Monitoring Unit is participating with several pharmaceutical companies in clinical research to evaluate the effectiveness of new medications.

Valley's Advanced Services

If epilepsy is ruled out and another medical condition is suspected, The Valley Hospital offers a complete range of pediatric services needed to diagnose and treat other problems. The Center for Child Development provides evaluations and treatment within a number of pediatric subspecialties in a convenient outpatient facility on Goffle Road in Ridgewood.

Dr. Cope received her medical degree from the State University of New York Health Science Center in Brooklyn, NY. She completed a residency in pediatrics at Schneider Children's Hospital on Long Island, NY. She completed a fellowship in pediatric neurology at Mount Sinai Medical Center in New York City and a fellowship in neurophysiology at New York University Medical Center. Dr. Cope has been on the medical staff of The Valley Hospital and director of the Pediatric Epilepsy Monitoring Unit since 2001.

For More Information

Patients are usually scheduled by their referring neurologist or Dr. Cope. For more information about the Pediatric Epilepsy Monitoring Unit at The Valley Hospital, please call 201-447-8311.